Wyniki wyszukiwania - Biblioteka Nauki

1

Non-Recurrent Laryngeal Nerve

100%

Buła G. , Mucha R. , Paliga M. , Koziołek H. , Niedzielski Z. , Gawrychowski J.

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nr 7

336-339

EN

The aim of the study was to assess the frequency of non-recurrent laryngeal nerves (Non-RLN). Material and methods. A total of 6110 patients were operated in our hospital between 1 January 2005 and 31 December 2013 for various goiters (5429) and various types of hyperparathyroidism (618). Laryngeal nerve was exposed during operation in 1700 patients from superior aperture of the chest to superior aperture of the larynx. Identification process of RLN was started with dissecting inferior thyroid artery (ITA) and its junction with the nerve. Then main trunk of the nerve was exposed backwards till the region of superior aperture of the chest together with the end portion till the nerve outlet to the larynx. Results. In the group of 1700 patients, RLN was exposed bilaterally in 1400 (82.4%) and unilaterally in 300 (17.6%). In the group of 3100 dissected RLNs the course of RLN was observed on the right side in 1710 patients and on the left in 1390. Irreversible nature RLN was shown in four cases (0.1%) – four women (02%) aged 42-55 (mean 49.3) – three operated for non-toxic nodular goiter and one for primary hyperparathyroidism. Each time the Non-RLN was seen on the right side. The other patients manifested recurrent character RLN. Moreover, interstitial course of RLN was found on the left side in one man. Conclusion. Non recurrent laryngeal nerve is a rare anatomical variation, occurring more frequently on the right side. Surgeon during surgery of the thyroid and parathyroid glands should be aware of its existence to avoid damage.

2

Total Thyroidectomy for Nodular, Benign Thyroid Diseases in Terms of Larynx Function Examinations - Is it a New Treatment Standard?

70%

Kaczka K. , Jankowski W. , Kopczyński J. , Kwiecień J. , Pomorski L.

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tom 82

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nr 1

4-11

EN

Aim of the study was the assessment of total thyroidectomy (TT) value as a treatment method of goiter with particular emphasis on the results of laryngological examination.Material and methods. From 15th April 2008 to 1st July 2009 there were 125 (72.7%) TTs, 12 (7%) TTs and appropriate lymphadenectomies, 9 (5.2%) near TTs, 14 (8.1%) lobectomies, 5 (2.9%) completion thyroidectomies and 6 (3.4%) other operations. Vocal cords function was assessed routinely one day before, two days after operation by an otolaryngologist. Voice quality was assessed by patients in VHI questionnaire theirselves.Results. Five patients had one-sided vocal cord paralysis before the operation. The one-sided transient recurrent laryngeal nerve injuries was observed in 16 other patients (9.3% among patients and 4.6% among nerves at risk) in the second day after the operation. There was no bilateral recurrent laryngeal nerve injury. From three to six months after the operation, 21 (among 23) patients with vocal cord movement disability were examined once again by the same otolaryngologist. The same vocal cord paralysis was observed in 4 sicks (one person died), which was found preoperatively. Seven (4%) other patients had permanent one vocal cord paresis. This represents 2% the nerves at risk. Three of them were recognized benign lesions and four thyroid cancer. Our percentage of early, postoperative hypoparathyroidism was 6.4% and persistent was 1.7%. VHI score in the group with paresis or paralysis of vocal cord gave the score of 4 to 90 points- an average of 49 points. In patients with proper vocal cord movement there were results from 0 to 6 points- an average of 2 points.Conclusions. 1. Total thyroidectomy in the treatment of bilateral goiter without malignancy features is radical and safe procedure. 2. It protects against goiter relapse and its consequences. 3. Complications rates after total thyroidectomy are at acceptable and comparable proportions to the other operation types.

3

Morphologic changes in the nodular goitre induced by the ligasure high frequency current generator

70%

Yermakova T.

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tom 09

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nr 3

EN

Today, surgical dissection and tissue coagulation with both monopolar and bipolar coagulation as well as LigaSure high frequency current generator (HFCG) are the surgical modalities of choice in the treatment of thyroid pathology. However, the question of the high frequency current effect on the morphofunctional condition of the posthemithyroidectomic parenchyma is still disputable. The goal of the research is a thorough histological analysis of the surgically removed thyroid tissue specimen. The nodular goitre of 50 patients was subject to the histological study. The surgery was performed with the LigaSure HFCG. The 1.0x0.5 thyroid tissue specimens were excised from three areas. Hemithyroidectomy lasted for 40-50 min and thyroidectomy – 120 ± 4.2 min. In both procedures, the blood loss was within 70-150 ml, no haemorrhage being observed in both intra-and postoperative period. The zonal effect of high frequency current on the thyroid structure was determined morphologically, namely coagulation necrosis in the site of direct action, intensified secretory response of the thyroid tissue to the extremal factor in the perifocal area, and typical structure of the nodular goitre with the signs of impaired microcirculation in the remote area. Morphologic changes of the thyroid gland, with high frequency current used as a dissector, are distance-dependent.

4

Expression of estrogen and progesterone receptors and Ki-67 antigen in Graves’ disease and nodular goiter

51%

Domoslawski P. , Pula B. , Lukienczuk T. , Podhorska-Okolow M. , Dziegiel P.

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tom 51

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nr 2